Could it Be "Lime's"? Lyme Disease & Some Thoughts on Diagnosis

One of the benefits (or drawbacks) of practicing medicine in Western Pennsylvania is that we're in the middle of an area in which Lyme Disease is highly prevalent. This prevalence has caused the general public to be very aware of Lyme Disease (or, as they call it, "Lime's Disease"--a phrase that instantly makes me cringe both for the mispronunciation and for the abyss I am about to descend). Such an awareness, in many ways, has mixed results. On the one hand, an informed patient is unequivocally better than one who is not: it can make diagnosis and treatment much easier as well as help with public health messaging regarding  precautions needed to take to avoid ticks. However, the general public is often unable to sift through all the misinformation about Lyme that exists and understand when it is truly a possibility and when it is arbitrary to suggest its involvement in an illness (let alone responsible for "chronic" symptoms).  I recently was asked to test for Lyme disease in a person with stroke symptoms.

Because Lyme disease has various stages and varied symptoms, many people have heard anecdotes about someone they know with mysterious symptoms that were eventually found to be due to Lyme disease. However, what must be kept in mind is that though there are rare cases of many conditions that have been shown to be the result of Lyme disease, they are a rarity and testing for Lyme disease in the absence of a real suspicion of a role for Lyme can lead one down the wrong path. It must be remembered that at least 10% of people with positive Lyme results have had asymptomatic infections and a positive antibody test will be meaningless if just tested as part of a "shotgun" approach to diagnosis.  

Chances are that any given person's stroke is caused, not by Lyme, but by atherosclerosis--indeed a major study on this topic said Lyme testing added "little value". The same is true is for the myriad other conditions that often get blamed on Lyme. This is not to say that Lyme isn't capable of being behind someone's nebulous symptoms, just that many people (physicians included) seize on Lyme when they're looking for a quick and easy answer.